Chief Complaint: “I have been having this lower back pain which started 5 days ago, and I am in lot of pain.” History of Present Illness: R.S. is a 40-year-old, Asian American female who presents to the clinic with lower back pain which started 5 days ago after lifting heavy boxes for her new house (onset). She stated that the pain is in the lumbar region of her back that radiates to her bilateral buttocks (location). She describes the pain as constant, sore (characteristic) and has been occurring daily nowadays (timing). She reports pain is constant but has intermittent intensities of aching and soreness throughout the day. (duration). The pain is aggravated by sitting, standing, bending forward and walking (aggravating). Rates pain at 7/10 at onset, patient takes Ibuprofen which relieves her pain and rates pain 4/10 (severity). Pain is partially relieved by resting, lying flat on back and taking Ibuprofen every 6 hours (relieving factors). Due to pain, she is having limited movements and pain is worse in the morning when getting out of bed after lying down all night. She denies having muscle weakness, numbness, tingling, bowel and bladder incontinence, fever, and weight loss. She does report having an increase in burping after meals. She states that time generally improves her pain but uses 2-4 antacid Tums every few days, offering partial relie She does report having an increase in burping after meals. She states that time generally improves her pain but uses 2-4 antacid Tums every few days, offering partial relie She does report having an increase in burping after meals. She states that time generally improves her pain but uses 2-4 antacid Tums every few days, offering partial relie Review of Systems (ROS) Constitutional: Patient is alert and oriented. Patient denies having fever, chills, night sweats, loss of appetite, weakness, fatigue, and unintentional weight loss. Musculoskeletal: Denies muscle weakness, joint instability or swelling. The patient has lower back pain which interferes with her daily activities. She has been having limited movements due to pain. Pain is radiating to her bilateral buttocks. Reports difficulty in bending forward, sitting, walking, and standing in upright position. She denies having numbness, tingling, loss of balance, bowel or bladder incontinence, fever, and unintentional weight loss. The patient denies having previous musculoskeletal injuries. Neuro: Denies having numbness or tingling, loss of balance, paralysis, tremors, weakness, fainting and seizures. Cardiovascular: Patient denies shortness of breath, palpitations, and lower extremities edema. Psych: Denies having depression or anxiety. Past Medical History Patient having Hypothyroidism- diagnosed in 2018. Hypothyroid is controlled and managed by medication. Vitals: Blood Pressure: Right arm: 145/90 mmHg, sitting position. RR: 19 cycles per minute HR: 85 BPM Temperature: 37.2 degree Celsius orally O2 Sat: 98% Weight:180 lbs. Height 5 ft 6 inches BMI: 29 Pain: Low back pain 7/10 Physical Exam General: RS is a 40-year-old female, overweight. She is alert, oriented and seems anxious due to lower back pain. The patient is well-developed, well-nourished and maintains good eye contact throughout the examination. Neurologic: Cranial Nerves II-XII intact. No numbness and tingling noted in both upper and lower extremities. DTRs intact. Musculoskeletal: Bilateral upper extremities with full range of motion of shoulder, elbow, and wrist. Bilateral upper extremity strength for neck, shoulder, elbows, wrist, and hands 5/5. Bilateral upper extremities and lower extremities without muscle atrophy, no evidence of swollen joints. Bilateral lower extremity with full range of motion of bilateral hips, knees and ankles, strength equal 5/5. The spinous processes of C7-L5 are palpable, midline, and tender to deep palpation right below L5-S1. Patient having difficulty when lying flat on bed and had moderate difficulty with straight leg raise both actively and passively. The pain level increases when patient tries to bend forward to touch her toes. Range of motion is reduced with flexion, extension, rotation of spine and lateral bending. Slumped posture noted with sitting and walking, and gait is steady. Include a clear outline of the accurate principal diagnosis AND lists the remaining 3 secondary diagnoses. Secondary diagnoses are active diagnosed medical conditions that relate to the chief complaint or incidental medical or social history findings discovered during the exam. The principal diagnosis must include a critical argument and supporting rationale in the following format: Pathophysiology/etiology: Demographics, risk factors: Common symptoms of condition (Subjective findings) Common signs of condition (Objective findings). Please also include a Rationale/Connection (Pertinent positive and negative gathered from patient subjective and objective data to support diagnosis).